Exercise induced bronchospasm

In some children, exercise induced bronchospasm (EIB) may be the only manifestation of asthma, whereas children with known asthma may experience worsening of their asthma symptoms during physical exertion. EIB may begin during or after vigorous exercise, and takes about 20 to 30 minutes to resolve after peak symptoms are experienced. EIB should be controlled so that it does not limit participation in sports. The severity of EIB will depend on how long and hard the exercise is, and how dry and cool the air is, as well as factors intrinsic to the child. Swimming for instance, is less likely to induce EIB than running, probably because of moist air being inhaled.
Ask about cough, shortness of breath, chest pain, chest tightness, wheezing, and difficulty keeping up with the other children while playing or exercising. If necessary for diagnosis, an exercise challenge with PEF or FEV1 measurements before, after, and at five minute intervals during a 20 to 30 minute exercise period may be performed. The test is considered positive if either measure declines by 15% or more.
Pre-treatment with inhaled beta2-agonists (or in some cases cromolyn or nedocromil) before exercise is successful in more than 80% of patients. In children with frequent symptoms, long term control medications, or a stepup in use of long term control medications for children who have asthma in addition to EIB, are indicated. Simple remedies, including warming-up before exercise, and wearing a mask or scarf over the mouth when exercising in cold weather, may be helpful. Being physically fit helps postpone the onset of EIB in susceptible patients. Children with EIB alone should be monitored periodically by pulmonary function tests (PFTs) to ensure that they continue to have no symptoms of asthma without exercise. [National: 2007], [SINHA: 2003], and [Randolph: 2008]

Authors & Reviewers

Initial publication: September 2008; last update/revision: September 2008
Current Authors and Reviewers:
Author: Lynne M. Kerr, MD, PhD

Page Bibliography

National Asthma Education and Prevention Program Expert Panel.
Expert Panel Report 3 (EPR-3): Guidelines for the Diagnosis and Management of Asthma - Summary Report 2007.
National Institutes of Health: National Heart, Lung, and Blood Institute; (2007) https://www.nhlbi.nih.gov/sites/default/files/media/docs/asthsumm.pdf. Accessed on Dec. 2019.
A 60-page summary of the 440-page comprehensive guideline; published by the National Heart, Lung, and Blood Institute.

Randolph C.
Exercise-induced Bronchospasm In Children.
Clin Rev Allergy Immunol. 2008;34(2):205-16. PubMed abstract

Recognition and Management of Exercise-Induced Bronchospasm .
American Family Physician. 2003;67(4). PubMed abstract